Pulmonary Tuberculosis

Tuberculosis, an infection, that invariably involves all parts of the body, except Heart muscle, Thyroid gland, Skeletal muscle and pancreas.It is a common infectious disease, especially in poor countries, notably in Angola, Bangladesh, Brazil, Cambodia, Congo, Central African Republic and many others countries, according to WHO (World Health Organization).Thediseasemainly caused by Mycobacterium tuberculosis, but sometimes it can be caused by Mycobacterium bovis (reservoir cattle) & Mycobacterium africanum (reservoir human).

Pathogenesis of the disease or How the Disease Develops:

M. tuberculosis is spread by inhalation of the respiratory droplet from an infected person during coughing, sneezing. After inhalation, the organisms enter into the lungs alveoli, then transform the macrophages into Epitheloid and Langhans cell and aggregates the lymphocytes in it to form tuberculous granuloma. Numerous granulomas aggregates to form 'Ghon focus'.

In the case of M. bovis the organism transmitted through drinking non sterilized milk from infected cows.

Types of Pulmonary Tuberculosis:

Based on the time of exposure it may be classified into Primary Pulmonary tuberculosis and Post Primary Pulmonary Tuberculosis or Secondary pulmonary tuberculosis.

In primary pulmonary tuberculosis the patient is not previously exposed to the organism, but in secondary pulmonary tuberculosis, the patient is already sensitized by the organism. in secondary tuberculosis, the patient may be affected either by exogenous i.e. from an infected person or by endogenous source i.e. reactivation of dormant primary lesion.

Category of Patients:

According to WHO (World Health Organisation) patients are classified into two categories for treatment purpose-

Category I:

New smear positive Pulmonary TB

New smear negative Pulmonary TB

Extrapulmonary TB

TB associated with other conditions, like AIDS.

Category II:

Treatment failure

Untreated patient

Maltreated patient

Clinical Presentation:

A cough often with hemoptysis (sputum mixed with blood) for 3 weeks or more.

Investigations:

Following investigations are invariably done for diagnosis of the disease-

Sputum for AFB (Acid Fast Bacilli)

Chest X-ray

MT test

GeneXpert TB test.

Complications that may develop if left untreated:

Massive Hemoptysis

Corpulmonale

Fibrosis of lungs

Atypical Mycobacterium infection.

Bronchiectasis

Obstructive pulmonary disease.

Prevention of the Disease:

Primary prevention of the disease includes vaccination against M. tuberculosis, immediately after birth.

Isolation of the infected patient from other patients, and using the mask for the patient is also important. Maintain personal hygiene and adequate treatment of the patient with the full course of medicine is very important.

Treatment of Pulmonary Tuberculosis:

The aim of the treatment is to cure the patient and prevent recurrence and spreading of the disease to the unaffected patient.

Two treatment regimens are followed for treatment of Pulmonary tuberculosis, one is six months regimen and another is eight months regimen.

Six months regimen is for Category I patient and eight months regimen is for Category II patient.